Low literacy has received limited attention in the "Year 2000" objective to increase screening mammography utilization by low-income women. Inaccurate knowledge and negative attitudes associated with low literacy may result in underutilization of screening mammography. The objectives of the proposed project are to increase utilization of screening mammography by women with low literacy skills and to provide information about factors associated with the decision to be screened. Specific aims are: 1 to develop a screening mammography educational program appropriate for women with low literacy skills; 2) to compare the efficacy of th tailored educational program with that of National Cancer Institute (NCI) printed materials in improving utilization of screening mammography by women with low literacy skills; and 3) to provide more information about the relationship of literacy an a woman's knowledge, attitudes, and decision to obtain a mammogram. The study will be conducted in three stages: materials development, program implementation, and evaluation. Materials development will involve focus groups of women aged 40 years and older who live in a housing project. Groups of women who have had a mammogram and groups who have not had a mammogram will discuss facilitators and barriers to use and possibilities for improving screening mammography utilization in their communities. The information will be used to refine a Screening Mammography Knowledge nd Attitudes Questionnaire (SMKAQ) based upon national survey questions and guidance from earlier focus groups. The information will also be used to develop a twenty minute educational program, which will contain a videotape as well as written and verbal material. The program will be implemented in small groups of women aged 40 to 75 years who are consecutive registrants at one of two outpatient clinics that serve a low-income population. A reading screening test and the SMKAQ will be administered to these women in a standardized manner. The women will then receive one of three interventions; 1) The developed education program, 2) NCI printed material, or 3) recommendation and referral only. Interventions will be systematically assigned to specific clinic days. Evaluation will be conducted using a telephone interview six months after the interventions. Subjects will be asked whether they obtained a mammogram (verified by medical records) and what factors influenced the decision. Data will be analyzed to determine: 1) if intervention groups differ in terms of obtaining screening mammography within six months of intervention; 2) which responses to the questionnaire best predict screening mammography utilization; 3) if literacy level is associated with mammography utilization; and 4) if questionnaire responses which predict utilization of the test are associated with literacy level.